Chad

Chad, called by some the “dead heart of Africa,” is an arid, landlocked country with few natural resources and many troublesome neighbors. Civil war rocked the population almost continuously from 1979 to 1993. It had barely emerged from this period when conflict in the Darfur region of neighboring Sudan and civil war in the Central African Republic began a refugee crisis in which tens of thousands of people fled across the eastern and southern borders. Decades of warfare and endemic poverty have had a deep impact on the health of average Chadians.

Chad's current population is 10 million, with an unknown and fluctuating number of refugees in border areas. The population is growing at 2.93 percent annually, with a birth rate of 45.73 births per 1,000 citizens, and a death rate of 16.37 per 1,000 citizens. The migration rate is officially 0.11 migrants per 1,000 citizens, but this figure may be skewed by the refugee situation.

A staggering 80 percent of Chadians live on less than $1 a day. The economy has been hampered by the history of civil unrest and a lack of infrastructure. Most Chadians are subsistence farmers, with the country's main exports being commodities such as cotton, sorghum, millet, peanuts, rice, potatoes, and manioc (tapioca). Since 2000, a consortium of foreign investors has been developing the country's oil resources, estimated at 1 to 2 billion barrels of recoverable crude; the first oil exports left the country in 2004. It is unclear how much oil revenues might help the average citizen in the future.

The population is at high risk for any number of waterborne and vectorborne diseases. About 42 percent have access to clean water, and only 9 percent have adequate sanitary facilities. Chad is located within the African Meningitis Belt. Measles, cholera, and hepatitis E outbreaks are common. Malaria is endemic and carries a fatality rate of between 7 and 12 percent. Respiratory diseases are prevalent within the refugee camps and quickly spread to neighboring communities. The AIDS rate stands at about 3.5 percent, with 180,000 people living with the virus and an estimated 11,000 deaths by 2005; 57,000 children under the age of 17 have been orphaned by the disease and 16,000 children under the age of 14 carry the virus.

Infant mortality is high, with 120 children per 1,000 dying before the age of 1 and another 208 per 1,000 dying between the ages of 1 and 5. Immunization rates for Chadian children remain poor, with less than 45 percent receiving protection from common illnesses. More than 50 percent of children are at work before the age of 14, and 72 percent marry before the age of 17. Child trafficking is a major problem within Chad, with an unknown number of young people sold into involuntary domestic or sexual slavery. Chad is also a transit point for children being trafficked between Cameroon, Nigeria, the Central African Republic, and other countries.

Female genital mutilation is widely practiced in Chad, with 45 percent of women having undergone the procedure in adolescence. The most common is type II (removal of the clitoris and labia), with type III (infibulation, or the removal of the clitoris and labia [Page 371]and sewing shut the labial and vaginal area) still in practice near the Sudanese border. The fertility rate is 6.7 births per women. Only 3 percent of Chadian women have access to birth control, and only 14 percent have a trained attendant monitoring deliveries. This has led to a high maternal mortality rate, with 1,100 maternal deaths per 100,000 live births.

...